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COVID-19 in hospitalized infants aged under 3 months: multi-center experiences across Turkey

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Abstract

To investigate coronavirus disease 2019 (COVID-19) in infants aged 0 to 3 months because there is currently a significant gap in the literature on the subject. A cross-sectional study was conducted with the involvement of 19 medical centers across Turkey and 570 infants. The majority of the patients were male (58.2%), and the three most common symptoms were fever (78.2%), cough (44.6%), and feeding intolerance (39.9%). The results showed that a small percentage of infants had positive blood (0.9%) or urine cultures (10.2%). Most infants presented with fever (78.2%). Children without underlying conditions (UCs) had mostly a complicated respiratory course and a normal chest radiography. Significant more positive urine culture rates were observed in infants with fever. A higher incidence of respiratory support requirements and abnormal chest findings were seen in infants with chronic conditions. These infants also had a longer hospital stay than those without chronic conditions.

  Conclusions: Our study discloses the clinical observations and accompanying bacterial infections found in infants aged under 3 months with COVID-19. These findings can shed light on COVID-19 in infancy for physicians because there is limited clinical evidence available.

What is Known:

• COVID-19 in infants and older children has been seen more mildly than in adults.

• The most common symptoms of COVID-19 in infants are fever and cough, as in older children and adults. COVID-19 should be one of the differential diagnoses in infants with fever.

What is New:

• Although most infants under three months had fever, the clinical course was uneventful and respiratory complications were rarely observed in healthy children.

• Infants with underlying conditions had more frequent respiratory support and abnormal chest radiography and stayed longer in the hospital.

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Abbreviations

CDC:

Centers for Disease Control and Prevention

COVID-19:

Coronavirus disease 2019

CSF:

Cerebrospinal fluid

IQR:

Interquartile range

MIS-C:

Multisystem inflammatory syndrome in children

PCR:

Polymerase chain reaction

RSV:

Respiratory syncytial virus

SARS-CoV-2:

Severe acute respiratory syndrome coronavirus 2

WHO:

World Health Organization

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Authors and Affiliations

  1. Izmir Tepecik Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey

    Gülnihan Üstündağ, Aslıhan Şahin & Dilek Yılmaz

  2. Department of Pediatric Infectious Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey

    Eda Karadag-Oncel, Şilem Özdem Alataş & Nurşen Belet

  3. Faculty of Medicine, Department of Pediatric Infectious Diseases, Gazi University, Ankara, Turkey

    Nursel Kara-Ulu & Meltem Polat

  4. Ümraniye Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey

    Enes Salı & Deniz Çakır

  5. Izmir Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Izmir, Turkey

    Aybüke Akaslan-Kara & Pelin Kaçar

  6. Faculty of Medicine, Department of Pediatric Infectious Diseases, Marmara University, Istanbul, Turkey

    Aylin Dizi Işık, Pınar Canizci Erdemli & Eda Kepenekli

  7. Clinic of Pediatric Infectious Disease, Kayseri City Hospital, Kayseri, Turkey

    Sevgi Yaşar Durmuş

  8. Clinic of Neonatal Intensive Care Unit, Kayseri City Hospital, Kayseri, Turkey

    Ahmet Özdemir

  9. Clinic of Pediatrics, Kayseri City Hospital, Kayseri, Turkey

    Binnaz Çelik

  10. Faculty of Medicine, Department of Pediatric Infectious Diseases, Istinye University, Istanbul, Turkey

    Murat Sütçü & Manolya Kara

  11. Faculty of Medicine, Department of Pediatric Infectious Diseases, Yeditepe University, Istanbul, Turkey

    Manolya Kara

  12. Clinic of Pediatric Infectious Diseases, Adana City Hospital, Adana, Turkey

    Tuğba Kandemir-Gülmez & Ümit Çelik

  13. Faculty of Medicine, Department of Pediatrics, Koç University, Istanbul, Turkey

    Aydın Çelikyurt

  14. Clinic of Pediatric Infectious Diseases, Manisa City Hospital, Manisa, Turkey

    Zühal Ümit

  15. Faculty of Medicine, Department of Pediatric Infectious Diseases, Koç University, Istanbul, Turkey

    Hacer Aktürk

  16. Clinic of Pediatric Infectious Diseases, Buca Seyfi Demirsoy Training and Research Hospital, Izmir, Turkey

    Kamile Arıkan

  17. Clinic of Pediatric Infectious Disease, Başakşehir Çam Ve Sakura City Hospital, Istanbul, Turkey

    Özge Kaba & Canan Caymaz

  18. Gülhane Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Ankara, Turkey

    Cihangül Bayhan & İsmail Zafer Ecevit

  19. Faculty of Medicine, Department of Pediatric Infectious Diseases, Cerrahpaşa University Istanbul, Istanbul, Turkey

    Deniz Aygün

  20. Faculty of Medicine, Department of Pediatric Infectious Diseases, Ankara University, Ankara, Turkey

    Döndü Nilay Penezoğlu, Halil Özdemir & Ergin Çiftçi

  21. Faculty of Medicine, Department of Pediatric Infectious Diseases, Bezmialem Foundation University, Istanbul, Turkey

    Özden Türel

  22. Faculty of Medicine, Department of Pediatric Infectious Diseases, Mersin University, Mersin, Turkey

    Mehtap Akça & Necdet Kuyucu

  23. Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Pediatric Infectious Diseases, Health Sciences University, Istanbul, Turkey

    Emel Çelebi-Çongur & Nazan Dalgıç

  24. Department of Medical Microbiology, Izmir Tepecik Training and Research Hospital, Health Sciences University, Izmir, Turkey

    Nisel Yılmaz

  25. Faculty of Medicine, Department of Pediatric Infectious Diseases, Izmir Katip Çelebi University, Izmir, Turkey

    Dilek Yılmaz

Authors
  1. Gülnihan Üstündağ
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  2. Eda Karadag-Oncel
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  3. Nursel Kara-Ulu
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  4. Meltem Polat
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  5. Enes Salı
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  6. Deniz Çakır
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  7. Aslıhan Şahin
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  8. Aybüke Akaslan-Kara
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  9. Pelin Kaçar
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  10. Aylin Dizi Işık
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  11. Pınar Canizci Erdemli
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  12. Sevgi Yaşar Durmuş
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  13. Ahmet Özdemir
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  14. Binnaz Çelik
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  15. Murat Sütçü
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  16. Manolya Kara
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  17. Tuğba Kandemir-Gülmez
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  18. Aydın Çelikyurt
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  19. Zühal Ümit
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  20. Hacer Aktürk
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  21. Kamile Arıkan
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  22. Özge Kaba
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  23. Canan Caymaz
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  24. Cihangül Bayhan
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  25. Deniz Aygün
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  26. Döndü Nilay Penezoğlu
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  27. Şilem Özdem Alataş
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  28. Halil Özdemir
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  29. Özden Türel
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  30. Mehtap Akça
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  31. Emel Çelebi-Çongur
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  32. Eda Kepenekli
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  33. Ümit Çelik
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  34. İsmail Zafer Ecevit
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  35. Nurşen Belet
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  36. Nazan Dalgıç
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  37. Nisel Yılmaz
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  38. Dilek Yılmaz
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  39. Necdet Kuyucu
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  40. Ergin Çiftçi
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Contributions

All authors have made substantial contributions to all the following: (1) the conception and design of the study, acquisition of data or analysis, and interpretation of data; (2) drafting of the article or critical review of it for important intellectual content; and (3) final approval of the submitted version.

Corresponding author

Correspondence to Eda Karadag-Oncel.

Ethics declarations

Ethics approval

The pediatric infectious disease clinic at Health Science University Izmir Tepecik Training and Research Hospital managed the research, which received ethical approval (decision number: 2022/12–19). Our hospital’s ethics committee unit was emailed data from the centers, and ethical approval documents with wet signatures from each participant center were mailed to the unit. All investigative procedures adhered to the principles outlined in the Declaration of Helsinki.

Consent to participate

Not applicable.

Consent for publication

All the patient data are anonymized, and parents and legal guardians consented to publication of the results of the project.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

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Üstündağ, G., Karadag-Oncel, E., Kara-Ulu, N. et al. COVID-19 in hospitalized infants aged under 3 months: multi-center experiences across Turkey. Eur J Pediatr 183, 1153–1162 (2024). https://doi.org/10.1007/s00431-023-05329-x

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